2014

PATIENT HISTORY

How would you diagnose and screen Miranda?How would you treat Miranda?

Are there any additional steps you would take?

Antimicrobial Resistance in N. gonorrhoeae – A Case Study

Miranda is a 20 year old student who will be returning home in the next few days for a summer job. She became sexually involved with a new partner about a month ago. She has no family physician.

She reports her LNMP being 2 weeks ago, abnormal vaginal discharge, pain during intercourse, and that these symptoms appeared 5-7 days ago.

2014

Antimicrobial Resistance in N. gonorrhoeae – A Case Study

DIAGNOSIS

Any patient with lower abdominal pain should receive a complete pelvic

examination

Perform a complete abdominal and pelvic examination (including speculum and

bimanual examinations)

Given high rates of concomitant gonorrhea and chlamydial infection, specimens should

be taken for both

Take endocervical swabs for gonorrhea and chlamydia

She is symptomatic (potential PID). Culture allows for antimicrobial susceptibility testing

and is important for contact tracing

Conduct NAAT (for both) and culture (for gonorrhea)

Colonisation can occur without anal penetration

Take rectal swabs, either culture or validated NAAT

Recommendation Rationale

2014

Antimicrobial Resistance in N. gonorrhoeae – A Case Study

She is symptomatic

Ceftriaxone 250 mg IM in a single dose PLUS

Azithromycin 1 gram PO in a single dose

TREATMENT

Miranda requires presumptive treatment

Recommendation Rationale

Follow-up is not assured as she is leaving town for the summer

Patients should be treated with combination therapy (two antibiotics)

2014

Antimicrobial Resistance in N. gonorrhoeae – A Case Study

Infection with one STI increases the chance of others being present

HIV transmission and acquisition is enhanced in people with gonococcal

infections

Counsel Miranda on prevention

• Any partner within 60 days prior to symptom onset should be:• Notified• Tested• Empirically treated regardless of

clinical findings and without waiting for test results.

COUNSELLING

2014

REPORTING

Report the case to local public health authorities

Antimicrobial Resistance in N. gonorrhoeae – A Case Study

Treatment failure should also be reported

Repeat screening for individuals with gonococcal infection is recommended 6 months post-treatment

Strongly encourage Miranda to return to repeat her test